Stimulant shortage enters sixth month — here’s why it’s happening and why it matters

Nancy Hardin is crying in front of a Walgreens pharmacy counter. 

About eight hours earlier, she used spare moments at her paralegal job to call five pharmacies, asking each the same question: “Do you have any Vyvanse?” 

When a Walgreens 30 miles away finally said yes, she called her son’s pediatrician to send over his prescription. She then called the Walgreens to confirm that they received the prescription. Everything was in order, and she finished her day at work.  

She left work and drove through Johnston County, North Carolina — far past her son’s school and past her house. When she reached the counter, the pharmacist said four words Hardin had heard too often:

“We don’t have that.”

As the pharmacist explained that they didn’t even have the drug in their warehouse, Hardin felt so defeated that she started sobbing. 

“Your child depends on you to take care of them and to give them the things that they need,” she said later. “And my children need this, and I can't get it for them. It's an awful feeling.”  

She’s not alone. Nearly 6 million people in the U.S. use stimulants — drugs like Vyvanse, Adderall, Ritalin and Concerta — for different reasons. But for the last six months, one thing has been standard for almost everyone: the rat race to get the drugs before pharmacies run out.  

The Food and Drug Administration confirmed a shortage of Adderall in October and estimates the shortage will be over by mid-May, a month later than previous estimates. 

The FDA has not declared a shortage on any close alternatives to Adderall. Still, more than a dozen sources reported that they must contact between five and 15 pharmacies before finding one with their prescribed stimulant and strength in stock. 

Caroline Jeter has worked at a community pharmacy in Chapel Hill for nearly five years, processing orders, filling prescriptions and answering phones. 

“Over 50% of our calls at this point, we know it's asking if we have Adderall or not,” she said. 

The first thing she does when she gets to work is check what brands are on the shelves — how many milligrams, if any at all. With every call, she hears the real people behind a national problem: one that eats at her conscience, though she knows it’s completely out of her control. 

How are people dealing with the shortage?

Victoria Soltis-Jarrett, a professor of psychiatric and mental health nursing at UNC, sees neurons in the brain like a pearl necklace. When one pearl breaks off the necklace, all the rest scatter everywhere. This is how she explains ADHD to her students. 

“Those circuits are not there, you know, they're not working properly,” she said.

When users take a stimulant, they are reconnecting broken communication between neurons, which encourages decision-making and ignites the brain’s frontal lobe, the part responsible for organizing and completing tasks. 

Throughout last year, Emily Smither, a student at UNC, found herself unmotivated and unable to complete tasks she had no issues completing before. She was diagnosed with ADHD on April 14. 

“Right when you step out of my office, I need you to start calling pharmacies,” her doctor told her moments after delivering her diagnosis. “I need you to email me the second you hear what Adderall dosages they have.”

Smither lives in an apartment building above a CVS pharmacy. After going through months of tests to get her diagnosis, she thought treating her illness would be the easy part. It wasn’t. She checked with five pharmacies in the area to no avail. 

One pharmacist said “It truly is the luck of the draw.” One said “There has not been a single day that they have not put in an Adderall order.” One simply said “It’s been a nightmare.” 

In January, Sydney Hardee, a UNC student with ADHD, began to take Concerta. She got her first bottle — a full, correct dosage — with no problem. A month later, she had to call more than 10 pharmacies before finding the drug. 

On a spring break trip from High Point to Wilmington, she was hoping to snag a refill at any pharmacy along her route. She plugged the route into her phone and called every pharmacy near the highways she was taking. 

After more than 20 calls to pharmacies across the state, navigating more than 20 automated answering machines, holding to speak to more than 20 human pharmacists and getting more than 20 nos, she just gave up. 

This monthly goose chase is an unavoidable reality for the more than 14 million stimulant users in the United States. 

Kayden Hunt, a student at UNC with ADHD, is on a 15 milligram dosage of Adderall XR (extended release), but her psychiatrist wants her to go up to 20 milligrams — almost an impossibility due to the shortage. 

“With finals coming up, it's a lot. Knowing that my dosage is less than what I'm supposed to have, it's been very hectic,” she said. 

Although it’s against medical advice, she’s begun drinking coffee to make up for the lower dosage. 

And beyond her lower dosage, she’s struggled to get her hands on any stimulant at all. Earlier in the shortage, she found herself paying $80 for an uninsured brand of amphetamine stimulant when her $1 Adderall prescription was out of stock everywhere else she tried. Another time, her only option was an uninsured brand for $250, but her pockets just couldn’t stretch that far. In times like that, she either saves her dosages for busy days or crams all her work early — racing to beat the soon-coming empty orange bottle. 

And the shortage hasn’t started its sunset yet. Hunt spent her most recent therapy session calling 10 pharmacies with her therapist to find the dosage and quantity of Adderall XR. 

How necessary is the drug? 

Hunt, who is 20, didn’t start taking Adderall until two years ago. But, for long-time stimulant users like Catharine Yoder, it usually starts the same way. 

“In the first or second grade, I saw that I was really struggling with math and focusing and classes, and I had multiple tutors,” Yoder said. 

Yoder, now a student at UNC, has been on stimulants — first Vyvanse and later Adderall — for about a decade, more than half her life. And in March, she found herself completely unable to get the drug that she had relied on for so long. 

She called her doctor to send her prescription to her usual pharmacy, and she got a text message confirming that they had the drug. And when she reached the counter, just like Nancy Hardin, the pharmacist told her that they simply didn’t have any. 

They put her on a waitlist, one that the pharmacist warned her was “pretty long.” She told her mother in Greensboro, and the pair called every pharmacy they could find in both Greensboro and Chapel Hill. Still, no luck, not even at the hospital. 

Each morning, she watched her pills slowly dwindle, eventually to zero. And then, she endured two weeks with no stimulant. It was rough. She endured symptoms of addiction withdrawal — dizziness, vomiting, fatigue.   

“I skipped a whole day of class, because I just slept for so long,” she said. 

After two hard weeks, she was able to find a steady refill at a Walgreens in Greensboro, and her mom drove the drugs an hour to Chapel Hill. 

“It’s definitely a long and anxious process. It's really tough to go through,” she said. 

But it’s also a necessary process. For many stimulant users, being medicated is not just a crucial part of their ability to focus — it’s a building block of their identity. 

For Eliza Meyer, school is just one part of her life that suffers when she doesn’t have access to Ritalin, a fast-acting alternative to Adderall.

“These medications, really, they impact our quality of life,” Meyer said. “They affect mood, they affect personal communication, they affect relationships, they affect temperament, learning. It goes way past just grades or homework or school.”

Meyer, now a sophomore at UNC, was diagnosed with ADHD in middle school. Without a stimulant, she’s quick to be agitated. She has less patience. She has less kindness. She relies on the drug to be easygoing and to be “the best version” of herself. 

For stimulant users like Meyer, being unmedicated is a far too common experience six months into the shortage. The FDA says the shortage should be over by mid-May, but to pharmacists and patients alike, it doesn’t seem to be letting up. 

Why is there a shortage? 

The FDA chalks the national shortage up to a “demand increase,” but to Cameron Mitchell, a clinical pharmacy specialist at UNC Medical Center, it seems to be a bit more complicated than that. 

Reason 1: Purchasing power

Mitchell suspects the demand side of the shortage is partly caused by hospitals. Major healthcare systems across the United States that own and operate these hospitals simply have more buying power than pharmacies. 

At UNC Hospitals alone, the psychiatric emergency room has between 60 and 70 beds filled at any given time. To treat these patients, hospitals like UNC purchase massive amounts of stimulants from large wholesalers like AmerisourceBergen and Cardinal. 

Community pharmacy systems, and even certain Walgreens and CVS regional distributors, don’t move as much product as major hospitals. Thus they fall lower on the purchasing chain than hospitals.  

This divide in purchasing power is felt even more by mom-and-pop pharmacies. 

Independent pharmacies purchase drugs from smaller wholesalers, like Durham-based Mutual Drug. Lindsey Kennedy, a psychiatric pharmacist at UNC Medical Center, said Mutual has often been unable to purchase certain drugs, not only stimulants, simply because some pharmaceutical companies won’t agree to contracts with smaller wholesalers. 

Reason 2: Patent profit

When a drug is launched, it is protected under patent exclusivity for a set period. Patent exclusivity means big money for pharmaceutical companies that produce these drugs, Mitchell said. 

Adderall and its alternatives are something Mitchell calls “me too” drugs. Drug companies want to get drugs on the market fast that mimic other successful drugs they have produced. Think the first version of Adderall, followed by Adderall XR years later, followed by the longer-acting Mydayis. This helps companies continue to turn high profits as their old patents expire, he said. 

In other words, when a drug is about to come off patent, a company might tweak a small aspect of it and repackage it in a gilded box to keep making more money. Manufacturers then shift their production lines to make more of the new, tweaked version, thus increasing patent-protected profits and diminishing supplies of existing drugs, he said. 

The same company that originally produced Adderall — Shire, which was acquired by Takeda Pharmaceuticals in 2019 — is also behind another familiar drug: Vyvanse. 

Vyvanse was approved by the FDA in 2007, two years before the Adderall XR brand name patent expired in 2009. For several years, Shire demanded thorough testing for the production of Adderall XR generics, which delayed its generic debut until 2012. 

Then, there was a shortage of Adderall XR in 2012 as Shire lost its grip on brand name exclusivity. By mid-2013, the company saw a 16% decline to $112.3 million in year-on-year Adderall sales. However, company profits remained high as sales of Vyvanse rose by 13% to $300 million year-on-year, as the drug was still patent-protected. 

In short, large pharmaceutical companies often cycle through similar products, reducing supply of the old, with quasi-renewed patents to keep profits high, Mitchell said. 

This year, supplies of Vyvanse and Adderall rebounded in January, two months after what Kennedy called a typical October shortage. Stimulant drugs often experience shortages every fall as manufacturers run out of annually allotted bulk ingredients approved by the Drug Enforcement Agency, so supplies dipping in the fall and rising in January (when DEA quotas are renewed) is fairly normal. 

However, this year, Kennedy said the supplies unusually dropped to zero after the new year for all amphetamine salt-based stimulants, like Adderall and Vyvanse — except for brand name Adderall, made by Takeda Pharmaceuticals. 

Reason 3: Prescription problems

“They'll do some trickery to try to get as many patients they can on that branded product, or at least what they put out subsequently, to try to keep some of that market share and soften the blow of falling off the patent cliff,” Kennedy said.  

Pharmacy benefit managers (PBMs) control formularies, or lists of covered medications, on behalf of health insurers. To drive consumer demand, drug companies like Takeda make deals with PBMs to alter formularies, forcing stimulant takers like Kennedy to jump through hoops to retain their old prescriptions. 

Kennedy had been using Concerta for three years. She began using it in 2019 after her daughter was diagnosed with stage four cancer. 

“It broke my brain,” she said. 

This December, she attempted to fill her prescription like usual and was told that she needed an updated prior authorization, which had lasted three years. 

Her insurance company, CVS Caremark, had switched their preferred agents sometime in the last three years. She now needed to go through a “fail first” — trying and failing Vyvanse and Adderall XR, both made by Takeda Pharmaceuticals — before she could be covered again for Concerta. 

Vyvanse loses its brand name patent during the third quarter of this year. Switching users to Vyvanse allows Takeda to protect their profits for a few more years, as users will likely continue using the brand name stimulant. 

Kennedy, a 20-year veteran in the pharmaceutical industry, suspects that Takeda gave CVS Caremark a bunch of money, likely in the form of rebates. These transactions do not have to be public or transparent under current federal law, and a bill to change this is currently stalled in the U.S. House. 

“From a patient level, it's totally absurd. But having worked in this before and navigated pharmacy benefit managers before — I knew that it's all about the money,” she said. 

When Kennedy is at the pharmacy counter refilling her own prescription, she knows the entire system, and she’s able to grapple with the niche problems that consume the stimulant industry. Others are not. She knows that the average person is too often lost in the confusion. 

“Then you add on the diagnosis of ADHD, where the actual symptoms prevent being able to access the dang treatment,” Kennedy said.